Emergency Rooms Gear Up for Explosion of July 4 Injuries

WASHINGTON -- As Americans gear up for the Fourth of July barbecues and festivities, the nation's emergency doctors, hand surgeons, and ophthalmologists brace for an influx of patients with fireworks-related injuries.

The Level I trauma center at the University of Kentucky hospital in Lexington is already crowded during summer months from a wide range of trauma injuries, emergency physician Dr. Ryan Stanton told MedPage Today. But fireworks injuries are grow more common as July 4th approaches.

About 9,000 fireworks-related injuries resulted in visits to the emergency department in 2009, according to the U.S. Consumer Product Safety Commission. Nearly 6,000 of those occurred during the 30 days surrounding the Fourth of July, said CPSC chairman Inez Tenenbaum on press event on the National Mall.

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"These injuries may range from simple burns to loss of fingers, other extremities, and even death," Stanton said.

Fireworks injuries occur most often in the males who are in the "risk-taking" age-group -- ages 15-19, and alcohol use is often a factor, he said. However, small children, or people who stood near as a firework or bottle rocket went wayward are also common firework accident victims, Stanton said.

"So many people are used to the safety of fireworks, we've seen them our entire lives, people think about them as safe," Stanton said. "I think we get a little lackadaisical about them."

People are especially laid-back about sparklers, said three physicians who spoke with MedPage Today.

Children jubilantly waiving sparklers are an omnipresent sight at July 4th celebrations throughout the nation, but they can cause serious burns to the eyes, Stanton said. Not only does the tip of a sparkler heat up to 2,000 degrees Fahrenheit, but it contains an alkaline chemical that can eat away at eye tissue.

Nearly half of fireworks injuries are head-related injuries -- 30 percent of which are eye injuries, according to the American Academy of Ophthalmology. One in four fireworks-caused eye injuries results in permanent vision loss or blindness, according to a press release from the AAO.

San Francisco-based ophthalmologist Dr. Andrew Iwach said he treats sparkler burns every year around Independence Day.

"Those burns can be obviously very painful, and can cause permanent damage," Iwach said.

He's also seen cases where kids use bottle rockets and firecrackers as weapons and fire them at each other.

"The reason they have that loud bang is because they are creating this explosion where you have small particles flying, and that can cause all types of trauma not only to the surface, but they can create a shock wave which can actually ultimately injure internal structures within the eye itself," Iwach said.

Aside from eye injuries, hands are also particularly susceptible to fireworks injuries, said Dr. Keith Segalman, a hand surgeon at Union Memorial Hospital in Baltimore.

Usually, the injury is to the patient's dominant hand and resulted from the person -- usually a teenage boy -- holding onto an M-80 or other large explosive device while it went off.

"There is usually such a blast effect that it deteriorates the tissues," Segalman said, adding that if a finger is blown off from a fireworks explosion, the digit usually cannot be reattached.

"These can be relatively life-altering events for teenagers and adolescents who think they're just playing with fireworks," he said.

Iwach and the American Academy of Ophthalmology recommend leaving fireworks to the professionals.

"Why take the chance of ruining a holiday, spending it in an emergency room and potentially end up with permanent vision loss?" Iwach said.

Segalman recommended always having a bucket of water handy when setting off fireworks, never attempting to relight an already-lit firework that has failed to detonate, and using a long match or lighter to light the fuse in order to eliminate contact between the firework and a person's hands.

Stanton recommended only using new fireworks purchased legally from a reputably dealer, following directions to the letter, and never buying illegal fireworks or attempting to make homemade fireworks.

"When you throw in the illegal and the homemade fireworks, you really crank up the danger," Stanton said.